In Vitro Fertilization Outcomes Research Articles

CART (Cocaine- and Amphetamine-Regulated Transcript): A New Identified Intrafollicular Mediator in Ovulation Induction Protocols

Background/Objectives: This study investigates the relationship between cocaine- and amphetamine-regulated transcript (CART) expression, leptin, and hormone profiles—specifically progesterone, testosterone, androstenedione, estradiol, follicle-stimulating hormone (FSH), and human chorionic gonadotropin (hCG)—across four distinct ovulation induction protocols (HMG, HMG/hCG, rFSH, and rFSH/hCG). It also investigates the relationship between follicle-stimulating hormone receptor (FSHR) Ser680Asn polymorphisms, CART expression, and in vitro fertilization (IVF) results, with the goal of better understanding how CART and FSHR polymorphisms affect ovarian response and oocyte quality. Methods: Data were obtained from 94 women who underwent controlled ovarian stimulation (COS) as part of their IVF therapy. Hormone levels, CART expression, and FSHR polymorphisms were measured across all four ovulation induction procedures. Statistical studies were undertaken to investigate the relationships between CART expression, hormone levels, and IVF results. Results: The study found no significant difference in body mass index (BMI) amongst the four stimulation procedures (p-values varied from 0.244 to 0.909). CART expression did not show a significant correlation with hormone levels throughout the whole cohort (progesterone, testosterone, androstenedione, FSH, hCG, and estradiol; p > 0.05). However, CART levels were adversely linked with the number of follicles > 12 mm (r = −0.251, p = 0.018), total oocyte count (r = −0.247, p = 0.019), and oocyte maturity (r = −0.212, p = 0.048). Furthermore, there was a strong negative connection between CART expression and thyroid hormone T3 (r = −0.319, p = 0.048). Among FSHR polymorphisms, the SER/SER genotype was related to greater CART levels (mean 4.198 ± 2.257) than the SER/ASN and ASN/ASN genotypes (p = 0.031). Conclusions: These data indicate that CART expression and FSHR polymorphisms may influence ovarian response and oocyte quality in IVF patients, possibly acting as biomarkers for evaluating ovarian outcomes in various ovulation induction procedures.

Melatonin supplementation attenuates cuproptosis and ferroptosis in aging cumulus and granulosa cells: potential for improving IVF outcomes in advanced maternal age

BackgroundAdvanced maternal age is associated with decreased oocyte quantity and quality and in vitro fertilization (IVF) success rates. This study aimed to investigate whether melatonin supplementation can improve IVF outcomes in women of advanced maternal age by modulating cuproptosis and ferroptosis.MethodsThis prospective cohort study included 161 women aged 35–45 years undergoing IVF-frozen embryo transfer cycles. Participants were assigned to either melatonin (n = 86, 2 mg daily for ≥ 8 weeks) or control (n = 75) groups. Cumulus cells were analyzed for cuproptosis and ferroptosis-related gene expression. Additional experiments were conducted on the HGL5 human granulosa cell line to assess mitochondrial function and metabolic reprogramming.ResultsMelatonin supplementation significantly improved IVF outcomes in women aged ≥ 38 years, increasing clinical pregnancy rates (46.0% vs. 20.3%, P < 0.01), ongoing pregnancy rates (36.5% vs. 15.3%, P < 0.01), and live birth rates (33.3% vs. 15.3%, P < 0.05). In cumulus cells from patients, gene expression analysis revealed that melatonin modulated cuproptosis and ferroptosis-related genes, including ATP7B and GPX4, with more pronounced effects in the ≥ 38 years group. This suggests melatonin enhances cellular resilience against oxidative stress and metal-induced toxicity in the ovarian microenvironment. In vitro studies using HGL5 cells showed melatonin reduced oxidative stress markers, improved mitochondrial function, restored expression of glycolysis and TCA cycle-related genes and modulated cuproptosis and ferroptosis-related gene expression. These findings provide mechanistic insight into melatonin’s protective effects against regulated cell death in ovarian cells, potentially explaining the improved IVF outcomes observed.ConclusionsMelatonin supplementation significantly improved IVF outcomes in women of advanced maternal age, particularly those ≥ 38 years old, likely by modulating cuproptosis and ferroptosis and enhancing mitochondrial function in cumulus and granulosa cells. These results suggest that melatonin could be a promising adjuvant therapy for improving IVF success rates in older women.

Catalyzing IVF outcome prediction: exploring advanced machine learning paradigms for enhanced success rate prognostication

This study addresses the research problem of enhancing In-Vitro Fertilization (IVF) success rate prediction by integrating advanced machine learning paradigms with gynecological expertise. The methodology involves the analysis of comprehensive datasets from 2017 to 2018 and 2010–2016. Machine learning models, including Logistic Regression, Gaussian NB, SVM, MLP, KNN, and ensemble models like Random Forest, AdaBoost, Logit Boost, RUS Boost, and RSM, were employed. Key findings reveal the significance of patient demographics, infertility factors, and treatment protocols in IVF success prediction. Notably, ensemble learning methods demonstrated high accuracy, with Logit Boost achieving an accuracy of 96.35%. The implications of this research span clinical decision support, patient counseling, and data preprocessing techniques, highlighting the potential for personalized IVF treatments and continuous monitoring. The study underscores the importance of collaboration between gynecologists and data scientists to optimize IVF outcomes. Prospective studies and external validation are suggested as future directions, promising to further revolutionize fertility treatments and offer hope to couples facing infertility challenges.

Combining single-cell RNA sequencing and network pharmacology to explore the target of cangfu daotan decoction in the treatment of obese polycystic ovary syndrome from an immune perspective

BackgroundPolycystic ovary syndrome (PCOS) is a heterogeneous gynecological endocrine disorder linked to immunity. Cangfu Daotan Decoction (CFDT), a classic Chinese medicine prescription, is particularly effective in treating PCOS, specifically in patients with obesity; however, its specific mechanism remains unclear.MethodsPart 1: Peripheral blood mononuclear cells were collected on egg retrieval day from obese and normal-weight patients with PCOS and healthy women undergoing in vitro fertilization (IVF)-embryo transfer. Next, scRNA-seq was performed to screen the key genes of bese patients with PCOS. Part 2: Active ingredients of CFDT and obesity-related PCOS targets were identified based on public databases, and the binding ability between the active ingredients and targets was analyzed. Part 3: This part was a monocentric, randomized controlled trial. The obese women with PCOS were randomized to CFDT (6 packets/day) or placebo, and the healthy women were included in the blank control group (43 cases per group). The clinical manifestations and laboratory outcomes among the three groups were compared.ResultsBased on the scRNA-seq data from Part 1, CYLD, ARPC3, CXCR4, RORA, JUN, FGL2, ZEB2, GNLY, FTL, SMAD3, IL7R, KIR2DL1, CTSD, BTG2, CCL5, HLA, RETN, CTSZ, and NCF2 were potential key genes associated with obese PCOS were identified. The proportions of T, B, and natural killer cells were higher in patients with PCOS compared to healthy women, with even higher proportions observed in obese patients with PCOS. Gene ontology and the Kyoto encyclopedia of genes and genomes analysis depicted that the differentially expressed genes were related to immune regulation pathways. Network pharmacology analysis identified that the key active components in CFDT were quercetin, carvacrol, β-sitosterol, cholesterol, and nobiletin, and TP53, AKT1, STAT3, JUN, SRC, etc. were the core targets. The core targets and their enrichment pathways overlapped with those in Part 1. Clinical trials in Part 3 found that CFDT reduced the dosage of gonadotropins use in patients with PCOS, increased the number of high-quality embryos, and improved the ongoing pregnancy rate.ConclusionCFDT can improve the immune microenvironment of patients to some extent, reduce their economic burden, and enhance IVF outcomes. The improvement in the immune microenvironment in obese patients with PCOS may be linked to targets such as JUN and AKT.

Fixed versus flexible gonadotropin releasing hormone antagonist protocol in women with polycystic ovary syndrome undergoing in vitro fertilization: An RCT.

Despite the extensive use of the gonadotropin-releasing hormone (GnRH) antagonist protocol in treating infertile women, particularly those with polycystic ovary syndrome (PCOS), there have not been sufficient evidence to compare the flexible and fixed variants in in vitro fertilization (IVF) cycles. This study aims to assess the treatment outcomes of flexible and fixed types of GnRH-antagonist protocol for IVF in women with PCOS. In this randomized clinical trial, 150 infertile women with PCOS, who were candidates for IVF, and referred to the Yazd Research and Clinical Center for Infertility, Yazd, Iran between October 2023 and February 2024 were included. Participants were divided into 2 groups (n = 75/each) based on the type of antagonist protocol (fixed or flexible). GnRH antagonist administration started on the 5 day of gonadotropin treatment in the fixed group. In the flexible group when there was at least one follicle 12-14 mm, GnRH antagonist was started. Finally, the number of metaphase II oocyte, the quality of embryos, the duration of the stimulation cycle, the dose of gonadotropin, the number of GnRH-antagonist, and the rate of ovarian hyperstimulation syndrome were evaluated. No statistically significant difference was observed in terms of cycle length and the total dose of gonadotropin between groups. Nevertheless, a notable distinction was observed in the total number of oocytes (17.84 vs. 15.5, p = 0.023) and mature oocytes (13.64 vs. 11.83, p = 0.019) in the flexible group compared to the fixed group. In conclusion, the IVF outcomes are more favorable in women with PCOS undergoing the flexible GnRH-antagonist protocol compared to the fixed protocol.

Detoxification as a potential intervention for improving in vitro fertilization outcomes: a comparative analysis of failed cycles before and after detox

Objectives: In vitro fertilization (IVF) success rates vary, posing challenges for patients with repeated failed cycles. Environmental toxins, including endocrine-disrupting chemicals, may contribute to IVF failure. Detoxification has emerged as a potential intervention to improve outcomes, but its efficacy remains uncertain. Methods: We conducted a retrospective analysis of data from 65 IVF patients undergoing detoxification at a private fertility clinic in Lagos, Nigeria, between 2020 and 2022. Demographic data, IVF history, and detoxification details were collected. Logistic regression assessed the impact of age and failed IVF cycles on live birth outcomes, with odds ratios calculated. Results: Of 65 patients, 33 achieved a positive pregnancy outcome after detoxification. A significant reduction in failed IVF cycles postdetoxification was observed (P &lt; 0.0001). Logistic regression indicated that older age and more failed IVF cycles were associated with decreased odds of live birth. However, detoxification mitigated this effect, reducing the odds of failed IVF cycles, although not significantly. Conclusion: Detoxification shows promise as an intervention to improve IVF outcomes in patients with repeated failed cycles. By reducing failed IVF cycles and enhancing live birth rates, detoxification may optimize reproductive success. Further research with larger sample sizes is needed to confirm these findings and elucidate underlying mechanisms. Nonetheless, our study highlights the importance of considering environmental factors and adopting holistic approaches to enhance IVF success.

Relationship Between Anti-Mullerian Hormone (AMH) and Other Influencing Factors with in Vitro Fertilization (IVF) Outcome of Iraqi Infertile Women

The clinical application of Anti-Mullerian Hormone (AMH) measurement has been proposed in the prediction of qualitative and quantitative aspects of assisted reproductive technologies (ART). The aim of this study is to investigate the role of AMH level and other influencing factors in the outcomes of in vitro fertilization (IVF) treatment. The study focused on AMH and its association with infertile women undergoing IVF. The population included in this study was 131 infertile women who sought therapy for infertility at Kamal Al-Samarra'ay Specialized Hospital. They were divided into three groups according to the level of AMH hormone; group A (0.5-1.5 ng/mL, n=52), group B (1.6-4 ng/mL, n=70), and group C (&gt; 4 ng/mL, n=9). Data collection was performed by means of a specially designed questionnaire, independent of demographic data. It included questions related to infertility. Statistical analysis was performed with SPSS 26. Clinical parameters of infertile women, infertility hormones and their relationship with AMH, as well as FMS-like Tyrosine kinase 1 levels, were all investigated. The study findings revealed a significant difference in the concentration of AMH between infertile women (p&lt;0.01). Our analysis further demonstrated that the level of AMH reduces with advancing age in infertile women. Additionally, a positive correlation was observed between the number of oocytes obtained and AMH levels in infertile women. Furthermore, the study found that AMH levels had an effect on clinical pregnancy outcomes. Specifically, the highest success rates for IVF were observed in women with normal AMH levels falling within the ranges of group B (6-4 ng/mL(. Additionally, the study demonstrated significant differences in AMH and TSH levels among infertile groups (p&lt;0.05). Our study concluded that there is a significant correlation between clinical parameters and IVF outcomes, which can provide information for future clinical interventions aimed at improving success rates. Our analysis highlighted the role of FMS-like Tyrosine kinase 1 in infertility, where higher FMS-like Tyrosine kinase 1 levels were associated with higher success rates in IVF. The results indicate that the FMS-like Tyrosine kinase 1 level is a valuable marker for confirming the success or failure of IVF and can help determine the appropriate treatment plan.

Effects of preconceptional vitamin D levels on in vitro fertilization outcomes in infertile patients with polycystic ovary syndrome: A retrospective cohort study.

Vitamin D plays various roles in different stages of reproduction, and abnormalities in its levels are associated with diseases such as polycystic ovary syndrome (PCOS). This study aimed to determine the relationship between initial vitamin D levels and in vitro fertilization (IVF) outcomes in PCOS patients. This retrospective cohort study included 1174 PCOS patients who consulted the Acıbadem Maslak Hospital IVF Clinic between January 2015 and March 2021. We investigated the effect of preconceptional vitamin D levels on IVF outcomes using data analysis with SigmaPlot 14.5. We found a significant positive correlation between preconceptional vitamin D levels and positive clinical pregnancy rates (p < 0.001) as well as increased endometrial thickness (EMT) on human chorionic gonadotropin (hCG) day (p < 0.001, r = 0.262). The optimal vitamin D cut-off value for predicting positive hCG test results was identified as 13.24 ng/mL, as determined by receiver operating characteristic curve analysis (sensitivity = 0.839, specificity = 0.677). No association was observed with other IVF outcome parameters, miscarriage rates, or clinical pregnancy rates based on EMT. The study suggests that PCOS patients with vitamin D levels above 13.24 ng/mL are more likely to achieve positive hCG results after IVF. These findings highlight the potential importance of vitamin D supplementation in improving pregnancy outcomes for PCOS patients. Additionally, increased EMT on hCG day may explain the higher clinical pregnancy rates associated with elevated vitamin D levels.

The effect of intratesticular autologous platelet-rich plasma injection on sperm retrieval rates and in vitro fertilization outcomes in couples with non-obstructive azoospermia.

To assess the efficacy of intratesticular injection of autologous platelet-rich plasma (PRP) in men with non-obstructive azoospermia (NOA) and a history of failed microdissection-testicular sperm extraction (mTESE) procedures. A prospective case series of a cohort study was conducted involving couples diagnosed with NOA. Patients with at least one failed mTESE procedure were included. Intratesticular PRP injection was performed using a standardized protocol. Follow-up assessments included sperm analysis, hormonal evaluation, and in vitro fertilization (IVF) outcomes. Data from 177 men with NOA were analyzed, with 135 patients meeting eligibility criteria. PRP treatment resulted in positive sperm retrieval rates of 27.5% in patients with one prior failed mTESE procedure and 16.4% in patients with two or more failed attempts. IVF outcomes showed fertilization rates of 86.4% and 100.0% in respective groups, with pregnancy rates of 36.8% and 22.2% per embryo transfer. Histopathological examination post-mTESE revealed varied patterns, including Sertoli cell-only syndrome and maturation arrest. Intratesticular PRP injection shows promise as a potential therapeutic approach for NOA patients with prior failed mTESE procedures, demonstrating improved sperm retrieval rates and favorable IVF outcomes. Further randomized controlled trials are warranted to validate these findings and refine the technique's efficacy in male infertility management to answer the question of whether PRP could significantly improve the second attempt retrieval rate.

The efficacy of orally administered L-carnitine in alleviating ovarian dysfunctions has laid the foundation for targeted in vivo use: a study employing self-control and propensity score matching.

This study aimed to evaluate the effectiveness of oral L-carnitine administration in patients after treatment failure to lay the groundwork for targeted in vivo use. A total of 515 In Vitro Fertilization (IVF) patients undergoing subsequent cycles were included after applying exclusion criteria. They were divided into a control group of 362 patients and a study group of 153 patients who received oral L-carnitine until oocyte retrieval.140 patients were matched according to maternal age, infertility duration, body mass index (BMI), day three top-quality embryos rate, by propensity score matching (PSM). The study investigated the relationship between L-carnitine treatment and in vivo oocyte maturation, normal fertilization, and subsequent embryo development. Following PSM, initial differences in BMI and Day3 top-quality embryo rate between groups were nullified, we created two comparable cohorts with highly similar characteristics. In the subsequent cycles, the study group showed significant improvements in in vivo oocyte maturation rate at retrieval (p=0.002), normal in vitro fertilization rate (p=0.003), blastocyst formation rate (p=0.003), and usable blastocyst rate compared to controls. Although there was no significant difference in the top-quality embryo rate on Day 3, the study group showed a 10% increase in the upper quartile (55.35% vs. 66.67%). The cumulative clinical pregnancy and live birth rates showed a significant improvement (59.82% vs. 68.42%,p=0.004, 47.41% vs. 59.80%, p=0.002). Furthermore, self-control analysis revealed substantial enhancements (p<0.001) in all outcome measures following L-carnitine administration, resulting in the birth of 74 healthy neonates without congenital anomalies. We theorized that daily oral intake of L-carnitine before oocyte retrieval could boost oocyte quality and embryonic development, thus improving IVF outcomes. Ongoing investigations hold the potential to offer valuable insights into the applications and mechanisms underlying the therapeutic effectiveness of L-carnitine.

Optimization of lipofection protocols for CRISPR/Cas9 delivery in porcine zona pellucida intact oocytes: A study of coincubation duration and reagent efficacy

A priority to facilitate the application of lipofection to generate genetically modified porcine embryos and animals will be the use of zona pellucida (ZP)-intact oocytes and zygotes. Recently, our group produced genetically modified embryos by lipofection of ZP-intact oocytes during in vitro fertilization (IVF). This study investigates the effect of two commercial lipofection reagents, Lipofectamine 3000 and Lipofectamine CRISPRMAX, on embryo development and mutation efficiency in ZP-intact porcine oocytes. We compared these reagents with the electroporation method and a control group using two sgRNAs targeting the CAPN3 and CD163 genes. The detrimental effects on cleavage rates were observed in both lipofection treatments compared to the control and electroporated groups. However, blastocyst rates were higher in the Lipofectamine 3000 group than in the electroporated group for both genes. Mutation parameters varied by target gene, with Lipofectamine 3000 achieving higher mutation rates for CD163, while all groups were similar for the CAPN3 gene. Overall efficiency was similar for both lipofectamines, confirming their feasibility for use. In addition, we evaluated the effect of coincubation time (4, 8, and 24 h) on IVF outcomes, embryo development, and mutation parameters. Results indicated that an 8-h coincubation period optimized fertilization and mutation efficiency without significant toxic effects. This study demonstrates that lipofection with either Lipofectamine 3000 or CRISPRMAX during IVF is an effective method for generating genetically modified porcine embryos without the need for specialized equipment or trained personnel, with efficiencies similar to or greater than electroporation. This study also highlights the importance of optimizing reagent selection and coincubation times. There is no difference between Lipofectamine 3000 and CRISPRMAXTM in terms of embryo development and mutation efficiency, and under our experimental conditions, the optimal coincubation time with lipofectamine is 8 h.

Luteinizing hormone supplementation with human menopausal gonadotropin versus low dose human chorionic gonadotropin during ovarian stimulation does not affect live birth rates after fresh and frozen embryo transfer.

Luteinizing hormone (LH) plays an important role in ovarian follicle maturation. Human menopausal gonadotropin (hMG) or low dose human chorionic gonadotropin (hCG) can provide LH supplementation during in vitro fertilization (IVF) ovarian stimulation, though studies directly comparing their impact on IVF outcomes are limited. The aim of the study was to determine whether LH supplementation with hMG versus low dose hCG during IVF stimulation affects live birth rate. Fresh and frozen embryo transfers (ET) from 2017 to 2021 after standard long or antagonist protocols supplemented with hMG (75-250 IU) or low dose hCG (50-100 IU) during stimulation cycles in our academic center were included. Statistical analysis was performed with T-tests, Mann-Whitney U tests, Chi-square, and multiple linear and logistic regression. Four hundred and sixty eight unique stimulation cycles resulting in 213 fresh and 412 frozen embryo transfers were analyzed. There was a lower mature oocyte yield (10.9 vs. 11.8, p = 0.044) but similar high-quality blastocyst yield (3.6 vs. 3.9, p = 0.11) for hMG vs low dose hCG. Live birth rates per transfer were comparable for fresh (42% vs. 49%, p = 0.24) and frozen (46% vs. 53%, p = 0.45) embryo transfers. Multiple logistic regressions showed no association between supplemental gonadotropin and live birth for both fresh and frozen embryo transfers. Fresh and frozen IVF-ET pregnancy outcomes were comparable after hMG versus low dose hCG supplementation, suggesting flexibility in supplemental LH dosing regimens that may address patient or physician preference or cost concerns.

The effects of growth hormone supplementation in poor ovarian responders undergoing In vitro fertilization or Intracytoplasmic sperm injection: A systematic review and meta-analysis of randomized controlled trials.

To evaluate the effect of growth hormone (GH) supplementation on outcomes of in vitro fertilization (IVF) or Intracytoplasmic sperm injection (ICSI) for women with poor ovarian response. Relevant randomized controlled trials (RCTs) were obtained through search in several databases including PubMed, Scopus, Clinicaltrials.gov, Google Scholar, and Cochrane Library. Outcome measures included live birth rate, clinical pregnancy rate, cycle cancelation rate, number of retrieved oocytes, number of transferred embryos, total dose of gonadotropin, duration of gonadotropin treatment, and peak estradiol level. Additionally, a meta-regression analysis was carried out to determine any potential linear relationships between these outcomes and IVF success. After analyzing 18 RCTs comprising of 1870 patients, the study found that GH supplementation improved the number of retrieved oocytes [standardized mean difference (SMD), 0.65; 95% confidence interval (CI), 0.29-1.00] and transferred embryos group (SMD, 0.80, 95% CI, 0.39, 1.21) as well as peak E2 level (SMD, 1.20; 95% CI, 0.59, 1.81). While reduced the total dose and duration of gonadotropin treatment (SMD, -0.82, 95% CI, -1.25, -0.39, and SMD, -0.63, 95% CI, -1.04, -0.22, respectively). The meta-regression analysis found no linear relationship between clinical pregnancy, live birth rate, or cycle cancelation rate and the outcomes measured (p>0.1). Based on the available evidence, GH supplementation appears to improve the outcomes of IVF or ICSI in women with poor response. However, there is a need for further RCTs with larger sample sizes to determine the cost-effectiveness of adding GH to conventional protocols of IVF/ICSI for treating infertility in women with poor ovarian response.

Enhancing outcomes in IVF laboratories: navigating the human element through leadership and emotional intelligence.

We analyze the psychological and interpersonal aspects of in vitro fertilization (IVF)laboratory operations, highlighting how human factors such as leadership style, emotionalintelligence (EI), and team dynamics influence the effectiveness of IVF treatments. We alsoexamine the role of personality dynamics in team functioning and the adverse effects of toxicbehaviors on laboratory performance and morale. The manuscript comprehensively reviews contemporary literature about leadership styles, EI,and team dynamics. It also includes a detailed analysis of the ramifications of their operationswithin IVF laboratories. The primary emphasis resides in determining how these humanfactors contribute to the overall efficacy of IVF treatments and following patient outcomes. The findings suggest that staff well-being is not just a concern, but a critical factor inenhancing successful IVF outcomes. Leadership styles that promote emotional intelligenceand healthy team dynamics significantly improve laboratory performance. On the other hand,a toxic workplace negatively impacts staff well-being and patient outcomes. The studyhighlights the need for management development and EI training as vital components ofsuccessful IVF laboratory operations, reassuring the audience that these measures can lead toimproved outcomes. This manuscript presents the case for an equitable operational framework that recognizes thevalue of soft skills and technical expertise in IVF laboratories. It underscores the significanceof emphasizing the human element in reproductive medicine, proposing that by prioritizingempathy and delineating the contributions of the human factor, the field can achieve itsmaximum potential and enhance outcomes for staff members and patients. The pivotal role offuture research in empirically substantiating the influence of these human factors in realizingsuccessful IVF laboratories cannot be overstated, and we urge the academic community toparticipate actively in this crucial area of research.

Factors Associated with Clinical Pregnancy following Assisted Reproductive Technology: A Comparative Cross-Sectional Study

Abstract Background: Over the years, the numbers of centres performing assisted reproductive technology (ART) have increased in urban regions of Africa. We reviewed a 10-year record of ART in a public hospital in a bid to determine the pregnancy rate and identify factors associated with achieving clinical pregnancy. Materials and Methods: This was a retrospective, analytical, cross-sectional study of 604 women who had undergone in vitro fertilisation (IVF) or IVF/intra-cytoplasmic sperm injection, over a 10-year period, at the [Institute of Fertility Medicine, Lagos State University Teaching Hospital]. Data were obtained from the medical records of couples who had undergone IVF at the study location and analysed using relevant descriptive and inferential statistics. Regression analysis was used to determine possible predictors of clinical pregnancy outcomes at 95% confidence level and significant P value of &lt;0.05. Results: The clinical pregnancy rate observed was 23.7%. Women aged ≥35 years of age had 2.9 odds of achieving pregnancy compared to women &lt;35 years of age. The quality of embryo and dose of the follicle-stimulating hormone used were not significantly different when compared in pregnant and non-pregnant women (P = 0.612 vs 0.881). Endometrial preparation techniques, number of embryos transferred, types of embryos transferred, sperm quality, and source of gametes used were not significantly different in pregnant and non-pregnant women. There was a 0.77 odds of achieving pregnancy when a day-5 embryo was used compared to a day-3 embryo (P = 0.008). Conclusion: Overall, these results emphasise the multifaceted nature of IVF outcomes, urging further research to elucidate the intricate factors influencing success rates in assisted reproduction.

Endometriosis and In Vitro Fertilization.

In vitro fertilization (IVF) is an established option for the management of infertility in patients with endometriosis, though there remains ongoing debate around the extent to which endometriosis may compromise IVF treatment success, in which fertilization and preimplantation embryo development occur outside the pelvis. Whether endometriosis impacts oocyte and embryo quality and/or endometrial receptivity remains central to this debate. Here, we review the current literature relating to the impact of endometriosis on IVF outcomes and management strategies to consider when performing IVF treatment.

Impact of Hysteroscopic Polypectomy on IVF Outcomes in Women with Unexplained Infertility.

Objective: To assess the effect of hysteroscopic polypectomy on the in vitro fertilization (IVF) results in infertile women with at least one prior negative IVF outcome. Methods: This retrospective cohort study included women who had attended the "2nd Department of Obstetrics and Gynecology of the National and Kapodistrian University of Athens" and "Iaso" Maternity Hospital from October 2019 to January 2023 for infertility treatment. The medical records of 345 women aged 18-45 years old without abnormal findings in hysterosalpingography (HSG) and with at least one previous failed IVF procedure were analyzed. The male factor was excluded, as well as a prior hysteroscopic removal of polyps. In 67 women, polyps were suspected during initial two-dimensional ultrasound (2D-US) examination. The final sample of the study comprised 40 patients, in which endometrial polyps were removed by hysteroscopy with the use of resectoscope. All patients underwent ovarian stimulation and IVF in the consecutive cycle using a short GnRh antagonist protocol. Main Results: After hysteroscopic polypectomy, 29 (72.5%) out of 40 patients had a positive pregnancy result: 26 (65%) clinical and 3 (7.5%) biochemical pregnancies were documented. There was a statistically significant difference between the number of clinical pregnancies before and after polypectomy (p < 0.001), as well as between the total number of pregnancies (p < 0.001). Secondary Results: Women with positive outcome were significantly younger and had significantly lower FSH levels (p < 0.007). They also had significantly higher AMH (p < 0.009) and peak estradiol levels (p < 0.013) and yielded more M II oocytes (p < 0.009) and embryos (p < 0.002). Conclusions: Hysteroscopic polypectomy in women with a suspected endometrial polyp using 2D ultrasound and a history of prior failed IVF attempt improves IVF outcomes in terms of the clinical and total number of pregnancies.

Telomeres and SIRT1 as Biomarkers of Gamete Oxidative Stress, Fertility, and Potential IVF Outcome.

The number of infertile couples undergoing in vitro fertilisation (IVF) has increased significantly. The efficacy of this procedure is contingent upon a multitude of factors, including gamete quality. One factor influencing gamete quality is oxidative stress, which leads to telomere damage and accelerates cellular ageing. Identifying new biomarkers that can predict the success of assisted reproduction techniques is a current relevant area of research. In this review, we discuss the potential role of SIRT1, a protein known to protect against oxidative stress and telomeres, which are responsible for genome stability, as biomarkers of gamete quality and assisted reproduction technique outcomes.

Influence of male body mass index on semen analysis parameters and in vitro fertilization outcomes.

Concurrent global increase of prevalence of obesity and male fertility implies link between overweight and obesity with male subfertility. This hypothesis is supported by numerous population-based epidemiological studies. Increase in body mass index (BMI) is associated with poor sperm quality in fertile, and more noticeable in infertile men. Nevertheless, some studies disprove damaging effect of BMI on semen quality. To examine the influence of men's BMI in infertile couples undergoing in vitro fertilization (IVF) on semen analysis parameters and IVF outcomes. Study encompassed all couples who underwent IVF at Gynecology and Obstetrics Clinic Narodni Front in Belgrade during 2018 and 2019. Exclusion criteria were azoospermia, conditions and diseases that could affect the semen analysis parameters (diabetes, malignant diseases treated with radiation and/or chemotherapy, trauma or surgery of the genital organs, mumps or undescended testicles in childhood). Evaluated semen analysis parameters included semen ejaculate volume, sperm pH, sperm count, sperm motility, and sperm morphology. IVF outcomes comprised total number of embryos, number and percentage of obtained good-quality embryos and clinical pregnancy rates. Based on BMI value, participants were divided into a group of underweight (Group 1), normally weight (Group 2), overweight (Group 3), and obese men (Group 4). After applying inclusion and exclusion criteria, 411 men (couples) were included in the analysis. The largest number of men were overweight, while the smallest belonged to the group of underweight participants. There are no significant differences in the semen analysis parameters between study groups. Correlation analysis shown weak and insignificant correlation between BMI and semen analysis parameters. The number and proportion of good quality embryos is significantly lower in overweight and obese study groups compared to normal weight and underweight groups (2.89, 2.91, 2.42, and 2.36, respectively, P = .041). The differences in other IVF outcomes: total number of embryos (3.61, 3.74, 3.21, and 3.37, respectively) and clinical pregnancy rates (41.26%, 43.09%, 42.78%, and 39.95%, respectively) between study groups were not significant (P > .05). BMI does not significantly affect semen analysis parameters, but a higher BMI is associated with a lower number and proportion of good quality embryos in IVF outcomes.

Investigating developmental characteristics of biopsied blastocysts stratified by mitochondrial copy numbers using time-lapse monitoring

BackgroundFor in vitro fertilization (IVF), mitochondrial DNA (mtDNA) levels in the trophectodermal (TE) cells of biopsied blastocysts have been suggested to be associated with the cells’ developmental potential. However, scholars have reached differing opinions regarding the use of mtDNA levels as a reliable biomarker for predicting IVF outcomes. Therefore, this study aims to assess the association of mitochondrial copy number measured by mitoscore associated with embryonic developmental characteristics and ploidy.MethodsThis retrospective study analyzed the developmental characteristics of embryos and mtDNA levels in biopsied trophectodermal cells. The analysis was carried out using time-lapse monitoring and next-generation sequencing from September 2021 to September 2022. Five hundred and fifteen blastocysts were biopsied from 88 patients undergoing IVF who met the inclusion criteria. Embryonic morphokinetics and morphology were evaluated at 118 h after insemination using all recorded images. Blastocysts with appropriate morphology on day 5 or 6 underwent TE biopsy and preimplantation genetic testing for aneuploidy (PGT-A). Statistical analysis involved generalized estimating equations, Pearson’s chi-squared test, Fisher’s exact test, and Kruskal–Wallis test, with a significance level set at P < 0.05.ResultsTo examine differences in embryonic characteristics between blastocysts with low versus high mitoscores, the blastocysts were divided into quartiles based on their mitoscore. Regarding morphokinetic characteristics, no significant differences in most developmental kinetics and observed cleavage dysmorphisms were discovered. However, blastocysts in mitoscore group 1 had a longer time for reaching 3-cell stage after tPNf (t3; median: 14.4 h) than did those in mitoscore group 2 (median: 13.8 h) and a longer second cell cycle (CC2; median: 11.7 h) than did blastocysts in mitoscore groups 2 (median: 11.3 h) and 4 (median: 11.4 h; P < 0.05). Moreover, blastocysts in mitoscore group 4 had a lower euploid rate (22.6%) and a higher aneuploid rate (59.1%) than did those in the other mitoscore groups (39.6–49.3% and 30.3–43.2%; P < 0.05). The rate of whole-chromosomal alterations in mitoscore group 4 (63.4%) was higher than that in mitoscore groups 1 (47.3%) and 2 (40.1%; P < 0.05). A multivariate logistic regression model was used to analyze associations between the mitoscore and euploidy of elective blastocysts. After accounting for factors that could potentially affect the outcome, the mitoscore still exhibited a negative association with the likelihood of euploidy (adjusted OR = 0.581, 95% CI: 0.396–0.854; P = 0.006).ConclusionsBlastocysts with varying levels of mitochondrial DNA, identified through biopsies, displayed similar characteristics in their early preimplantation development as observed through time-lapse imaging. However, the mitochondrial DNA level determined by the mitoscore can be used as a standalone predictor of euploidy.